As you imply, NSAID injury can affect not just the upper GI tract but also the small and large intestine. Indeed, even in the absence of inflammatory bowel disease, injury occurs to the extent of causing so-called NSAID enteropathy, which can result in symptoms mimicking inflammatory bowel disease. As a rule, therefore, I discourage my patients from using NSAIDs for pain management (e.g. joint pain) but rather try and stick to acetaminophen and the like — though it may not always be helpful. The selective COX-2 inhibitors (e.g. celecoxib) are thought to be less harmful to the lower GI tract. That would be an option to consider. Can one be absolutely sure that this class of drugs is safe? Not really. We await more studies. Drugs like celecoxib may reduce bleeding risk, however.